Client Satisfaction Survey - Youth

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential. Thank you for your time.

* indicates required information.

1. Your Information

1-5   6-10   11-20   20-30   Over 30
Yes   No
Yes   No


2. How would you rate the service you received?

5 = great | 4 = good | 3 = okay | 2 = fair | 1 = poor | Don't know

  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know


3. Please rate the Progress you made with support.

5 = great | 4 = good | 3 = okay | 2 = fair | 1 = poor | Don't know

Effectiveness:

  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know

Personnel: Mental Health Clinician (counsellor)

  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know

Reception:

  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know

Facility:

  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know
  5   4   3   2   1   Don't know







Important: Click the "I'm not a robot" checkbox above, before clicking the 'SEND' button.